Healthcare Provider Details

I. General information

NPI: 1528066644
Provider Name (Legal Business Name): COLEMAN EYE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 HIGHWAY 82 W
GREENWOOD MS
38930-2720
US

IV. Provider business mailing address

2005 HIGHWAY 82 W
GREENWOOD MS
38930-2720
US

V. Phone/Fax

Practice location:
  • Phone: 662-455-4523
  • Fax: 662-455-3790
Mailing address:
  • Phone: 662-455-4523
  • Fax: 662-455-3790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateMS

VIII. Authorized Official

Name: TARA E KELLY
Title or Position: INSURANCE REPRESENTATIVE
Credential:
Phone: 662-455-4523